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L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kimberly Ann Franzese
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFEREN~avrica
C. SURNAME AFTER MARRIAGECo1e
(OPTIONAL. SEE REVERS'l!l94-52-3828
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ~Y put chess
(STATE) ~ (COUNTY)
C. CHECK 9NE 0 CITY 0 TOWN 0 VILLAGE
~~~clF'f:.agrange
D. STREET ADDRESf ualey Kd
COUNTY Dutchess
CITY/TOWN Wappinger
~~J:f:1368 .
~~~~J~R27
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
David Brian Cole
MIDDLE CURRENT SURNAME
I
1 . A. FULL NAME
11. A. FULL NAME
FIRST
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSEh71_60_6294
D. SOCiAl SECURITY NUMBER '
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY""b TOWN 0 VILLAGE
~~~CIFY Laoranoe
D. STREET ADDRESS 2 Daley Rd ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YEtO NO
11 /01 /1968
MONTH DAY YEAR
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
~
'12603
ZIP
3. A. AGE41
3B. DATE OF BIRTH
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGr?.7 3B. DATE OF BIRTH 02 )1
MONTH DAY
~
OYESQNO
ygr3
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Telecom Tech
B. TYPE OF INDUSTRY OR BUSINESS Communications
5. PLACE OF BIRTHCleveland, Oh
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Edward Alovsius
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Rose Marie Dusek
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARI'lIAGE 3
14. EMPLOYMENT
A. USUAL OCCUPATIO~MT
B. TYPE OF IND~TRY OR ~LlSINES~~edlcal
15. PLACE OF BIRTt-P-ronx, New Y orl<
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAMAnton Matthew Vavrica
'B. COUNTRY OF BIRT~ S A
17. MOTHER
A. MAIDEN NAMESharon Lenora Tyner
B. COUNTRY OF BIRTt!J S A
L
18. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES 19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV2RCE CIVIL ANOULMENT OaTH D1VORCE CIVIL A~NULMENT D(i'TH
B. HOW 010 LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW 010 LAST MARRIAGE END? (3) '6 DIVOcr3 (3) c:3rNULMENT 20~)e DEATH
C. DATE LAST MARRIAGE ENDED? 08 / 17 / 2009 c. DATE LAST MARRIAGE ENDED? / /
MONTt!; DAY YEAR MON'Q;II DAY" ~ YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? !:l YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
..
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATElCDUNTRY, IF NOT USA) SELF SPOUSE iMONTH,DAY",YEAR) (CITYlpqllNTY. STATElCOIlIfTRY. IF ,N}lT UIlA) SELF SPOUSE
1ST 08/17/2009 Goshen, New York ~ 0 1ST u3/31/2u10 PoughKeepSie, New YOrK 0 '6
2ND 12/22/2003 Goshen, New York 0 ~ 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I duly swear/affirm, dep.ose and say, that to the best of my knowledge and belief that the information I provided is true a legal impediment exists
as to my right to enter into the rr age state.
21. SIGNATURE OF GROOM. 22. SIGNATURE OF BRIDE.
29. OFFICIANT
NAME (PRINT)
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) t S
SIGNATURE~
by New York Domestic
USE
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license Is to be used onl for the purpose of a second or subsequent ceremony.
t-'-.. 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) John C. Masterson
04/12/201 0 TIME MONTH YEAR
SEAL SIGNATURE ~ . . DATE 11' 39
'-v-I MA~~GIOO~af~b in ers Falls, NY 12590 .:~ 04 13 2010
STREET CITYITOWN STATE ZIP
~~~R~~RT~~J lo~O~~~N~i~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME M . AY YEA 0 0 RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
MONTH
YEAR
06
11 2010
28. PLACE WHERE MARRIAGE OCCU~
A. STATE NEW YORK B. COUN ~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF 0 TOWN OF I!(VILLAGE OF
SPECIFY /I.Jkp"oi II k YLGs ~